{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T19:36:14Z","timestamp":1788809774719,"version":"build-2803163510"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T00:00:00Z","timestamp":1737504000000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Consensus is lacking regarding the management of extramesorectal lymph nodes (EMLN) in rectal cancer. Using simultaneous integrated boost intensity\u2010modulated radiation therapy (SIB\u2010IMRT), we targeted involved EMLN and reserved lateral pelvic lymph nodal dissection (LPLND) for nonresponders. The primary aim of this work was to determine the proportion of patients who avoided LPLND and to establish the pathological EMLN positivity rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Consecutive patients with rectal cancer with suspicious EMLN [short axis dimension (SAD)\u2009\u2265\u20097\u2009mm], receiving SIB\u2010IMRT as part of neoadjuvant chemoradiotherapy and subsequently undergoing total mesorectal excision (TME) or watch\u2010and\u2010wait, were included. Our primary objective was to determine the proportion of patients with a good nodal response (EMLN SAD\u2009&lt;\u20095\u2009mm) who were spared LPLND. The 3\u2010year locoregional relapse rate, distant metastasis\u2010free survival (DMFS) and overall survival (OS) were also assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 61 patients studied, 38 (62.3%) responded well to SIB\u2010IMRT. In this group, 32 patients underwent TME alone and six were observed as per watch\u2010and\u2010wait. The remaining 23 (37.7%) patients with persistent EMLN received TME with LPLND. On pathological evaluation, 7 (30.4%) patients had positive nodes while 16 (69.6%) were negative. At a median follow\u2010up of 32\u2009months (95% CI 23.3\u201340.7\u2009months), 10 (16.4%) patients developed distant metastases while none had local or pelvic relapse. The resultant 3\u2010year DMFS and OS for the whole cohort were 84.4% and 95.1%, respectively. Overall, 5\/61 (8.2%) patients encountered radiation\u2010induced toxicity of grade 3 or above and 8\/55 (14.5%) patients had severe postoperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SIB\u2010IMRT targeting EMLN followed by selective LPLND exhibits excellent oncological outcomes. While patients responding to SIB\u2010IMRT safely avoid LPLND, the potential for increased morbidity in nonresponders must be considered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/codi.17292","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T02:59:32Z","timestamp":1737601172000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Simultaneous integrated boost intensity\u2010modulated radiation therapy targeting clinically involved extramesorectal lymph nodes in locally advanced rectal cancer: A retrospective study"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5852-0170","authenticated-orcid":false,"given":"Prashant","family":"Nayak","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Tata Memorial Centre  Mumbai India"},{"name":"Homi Bhabha National Institute DAE, Anushaktinagar  Mumbai 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